Ready... Set... DUCK

In my years as a nurse I've seen a lot of vomit. Not one of the perks of my job... but just a part of my job. I handle it with grace, as it generally doesn't really bother me. Not much really bothers a nurse, and if it does, you get over it real quick your first year.

But tonight... I saw something completely different.

I was helping a fellow nurse in her new patients room. He was in an accident after drinking and had broken a few bones. So here he was. He was not allowed to sit up in the bed at all, he had to lay flat in the bed (related to some of his injuries). We were cleaning him up and turning him from side to side. He is an alert and oriented patient. He knew where he was and he had the ability to verbalize with us his thoughts and feelings. However, he was not able to tell us when he decided to projectile vomit across the room. Now I have seen projectile vomiting... but this was amazing. It literally flew across the room, hit the wall with such force that it splattered all 4 walls and the ceiling. It was like a damn firework show! The lucky part of the situation was that the patient chose to turn towards his nurse... not to me. The unfortunate part of the situation was that it was rank old-alcohol-dinner vomit. UGH! So while I don't generally have issue with smell it surprised me when I started to dry heave and had to make my way out of the room. But the kicker of the WHOLE situation was that as I started to make my way to the closest phone to call for housekeeping... I noticed the other nurse in the room. This poor nurse was frozen in her tracks and completely covered in vomit. She had it in her hair... all over her scrubs... she was soaked (remember, we had no warning). I almost died.

As soon as I get out of the patients room I crack up hysterically... it's how I keep from just crying... but I can't even breath at this point. Luckily the other nurse followed me out of the room and laughed as well... think we were both in shock.

But don't worry, we got her new scrubs and a shower. The other nurse was a trooper last night... something tells me that I would have stripped down to my skivvies and gotten in my car and gone straight home to my shower OR I would have begged the ED to let me use the decon shower (and get a high pressure hose down!).

Ah... the Friday night before Halloween. How special. Mental note for next year...

The Crash Cart

So last night was by far one of the most hysterical nights of my life!!! By hysterical I mean, if I didn't start laughing (and stay laughing) I would have ended up in tears. And I hate to cry... for any reason... but especially out of frustration. At the end of my shift one of the tech's told me that I looked tired. Well.... YEAH, but thank you... I look like shit!

I will have many blog postings about last night... but I feel that I must start with the Crash Cart story... because it makes the least amount of sense to me. And it really was the starting point of my night. BTW, for my non-medical readers, the Crash Cart is the cart that they bring into the room when a patient has stopped being alive. It has the shock paddles (you know the medical shows, when they yell "clear") and all the other fun gadgets and drugs that we use to restart a life.

Well, this evening, on my ventures through my nursing unit I noticed that the crash cart was looking a little wonky... so I went to do my check on it and found that it had been opened and not put back together and locked. Which is unusual, but not altogether impossible, sometimes in a pinch we will break into the cart to find a piece of equipment that seems to be eluding us. But generally, we immediately return to the cart and replace the borrowed item with a new one and lock the cart back up. And to add to my dismay, someone had done me the favor of pulling all of the latex gloves OUT of the box and leaving them strewn all over the cart. Helpful... really. So I clean up the situation and put the cart back together. (For those of you who have had to do a cart check... tedious and time-sucking work).

So I walk up to some nurses on the unit and told them about what I found. To which one of the techs told me that he saw some group of ADULT visitors rifling through the cart.

Well... that changes my opinion of a few things... including how my friday night was going to go.

First... WHY the hell would you see something like this and not a) stop them or b) tell someone else so that they could stop them!!

Two... as a visitor, WTF do you want that could possibly be in a crash cart? And... if you were looking for drugs... the only ones that we really have will either stop your beating heart, start your non-beating heart, put you in a coma (which will stop your breathing), and other such non-entertaining medications. And to top it off, the drug section of the cart... which is the visible TOP of the cart, is still sealed and safe. So the visitors were rifling through the drawers for what??

Three... who has the balls to just break into a cart in a nursing unit with people milling around 24/ 7, looking for some unknown medical equipment. (But then again... they did it, witnessed, and got away with it.)

And Four... these visitors were adults. Adults!!! Aren't they supposed to know better?? Another fine example.

So... deep breath... WELCOME FRIDAY NIGHT.

911... what is your emergency?

So when you call 911, they will always ask you "what is your EMERGENCY?"

I'd like to know how a 40-something patient explains that her 'emergency' is that she had a "cough that started yesterday and was bothering her" with a straight face.

She was alert and oriented, ambulatory, and without mental deficiencies. Although I'm prone to not believe the last characteristic to be true.

But she called 911... she was dead serious... she took the ambulance in... and she would not leave when they wanted to discharge her. She made the ED docs life such hell that they finally admitted her.

And as you guessed it... she did not have medical insurance AND her cough was creating her so much pain that she needed some narcotics as soon as possible. LIKE NOW!!!

Mesh panties

So the other day a patients family member came out to the nursing unit and asked if we had underwear for the patients.

The nurse informed this "wife" that we only had one-size-fits-all mesh panties for the female patients on their menstrual cycle (to hold the sanitary napkin in place... duh). Ick... I know. Sorry.

So the "wife" went away for a while. Later she showed up again requesting these mesh panties. Well... we already explained what they were so we handed them over without question. (Although we were all very curious!)

Later in the shift the nurse entered the MALE patients room and found the patient lounging around in these mesh panties.

EEEWWWWW! and Why??

Dressing change hell

So you are covered in abscess's. Where did these abscess's come from?? You are using heroin and meth... and apparently you think the best route is "skin popping."

NOT my issue.

But you want treatment for these abscess's... cause I'm sure the are causing you pain and issues. Fine... welcome to our hospital. The doctors admit you, they treat you with antibiotics, and they even take you to minor surgery and clean some of these abscess's out.

You are a guest in this fine hospital of ours. We are feeding you, we are boarding you, we are giving you medicine's finest antibiotics to rid you of these pests, we are giving you pain medicine for the discomfort you must feel after years of "skin popping" that you applied upon yourself, and we are changing your abscess's dressings so that you might heal. SO PLEASE DO NOT SCREAM BLOODY MURDER TO THE NURSE WHEN THEY ARE DOING THESE THINGS FOR YOU.

And... going AMA so that you can go get your "fix" so that you can "handle" your dressing changes will not be tolerated. We will NOT save your bed for 5 hours, so that when you return we can give you MORE drugs and then try to "treat" your condition.

Cause NOW... I DON'T GIVE A SHIT. If you want those "pesty" abscess's off... I'll just take your arms off completely. Try smoking your meth or shooting up your heroin without arms.

Take a picture, please... I'd like to see it.

Tattoo's and IV's

If there is one thing that I get a lot of experience in, it is starting IV lines. I often get called by nurses on my unit to start an IV, difficult or otherwise. Sometimes we are forced to put and IV in a foot... not our first choice, but if their veins are shot in their arms... we go for the feet. I've done it all.

I actually like putting IV lines in, but I don't just put them in for fun. I really only try if I think I have a good chance at getting the line in.

But a few pet peeves about putting lines into patients...

One... please don't tell me where to put the IV. I will a) think you are an IV drug user, if you know where to put it. and b) I will NOT put the IV where you "like" it best, I will PUT it were my nursing judgment tells me the best place is.

Two... if you are covered in tattoo's, don't tell me you are afraid of needles. Because I won't understand. And yes, I've gotten a tattoo or two. So don't play that card. I won't get it and I really won't try to... suck it up.

Three... If you have a tattoo, don't explain to me that a certain IV line might RUIN your tattoo. Because when we can't get a line in you to give you your Dilaudid and Ativan... guess you got to choose... the IV or the tattoo. Cause you can't have both.

And FOUR... the most obnoxious one on the list. I really don't want to start the IV between your tattoo'd ladies nipple and the snake tongue. So while I like starting IV's, this still seems a little over the line for me.
*In my head... tourniquet, check; gloves, check; IV setup, check; needle, check; alcohol, check; landmark... OMG... nipple and tongue.*

F this.

Many unknown

We admitted an elderly patient last night with a left hip fracture.

Many issues came to light with this particular admit...

First... the patient had been walking around on this fractured hip for over a week. The patient claims that they saw their naturopathic physician after a fall last week. The doc told them that all they needed to do was rest and take Tylenol if absolutely necessary. As you can see, the patient turned back to western medicine and brought themselves to the hospital when the pain was just too much to take.

Second... to get the patients pain under control we had to use Morphine, Valium, and Dilaudid. How the heck did the patient get by at home??

Third... my favorite, the allergy list. One form said "many unknown." WTF does that mean?? Another form said "almost all medications." I think the naturopathic physician filled the patients head with some really good ideas. Honestly... if you tell us you are allergic to almost all medications... guess we can't give them to you. Unless you, as the patient, cannot tell me when you had a certain medication and what your reaction to it was... guess we are going to test the medication out. You just took three narcs... trial and error??

**This is not meant to sway any opinions regarding naturopathic medicice or slander naturopathic medicine in any way. It is just a story. As a healthcare provider I respect all people and their practice and/ or beliefs. It is simply unfortunate that this patient lived in pain for over a week.**